Halthis has had the circuit on standby for a few minutes anyway, circulating at the lowest speed with isotonic there wasn't much else in need of tweaking but she didn't want to risk waking him by disconnecting it. She taps the controls to give another dose of beta blockers, because his blood pressure is still borderline-high and recirculating the blood back into him will bump it higher, and then she has it unhooked and the machine off in less than thirty seconds. 

"There. We managed to get everything back to normal - are you noticing any difference?" 

Kalorm considers this. 

...Actually, yeah? It’s hard to pin down what feels better, it’s mostly just - about 25% less vague undifferentiated terribleness?

He’s still tired and foggy, but his head feels less stuffy, and making plans feels a little more possible, less like trying to drag himself through a mixture of sand and glue. He’s still dizzy, but moving his head feels more allowed. The nausea is still waiting in the background but further back. 

He takes an experimental deep breath. It hurts more than before, but not intolerable, and - he thinks? - it’s a little less effortful. 

His mouth tastes terrible again, and he’s thirsty, but it feels easier to cope with when it’s not also making him intensely nauseated (in the particularly frustrating pointless way where he can tell that there’s nothing actually in his stomach to throw up.)

He nods. 

“I’m really glad!” Halthis is so pleased with herself. “If the sound was tolerable with noise-cancelling headphones, then - one second—” refresh Diagnostic markets screen, “then you’re likely to be sliding outside the normal range again within 12 to 18 hours, and after that you may need another session but you may not, if your native kidney function improves enough.”

How is Merrin being pleased with herself so much less annoying. He wants Merrin to be the one running future dialysis  that sounds so complicated to try to convey. He can tell Khemeth if and when his brother ever shows up again. How much sleep can he possibly need. It’s been, like, at least twelve hours???

Halthis has no idea what that expression means, but isn’t particularly inclined to burn a whole precious question - or five - on figuring it out. She’s pretty sure Kalorm will make it obvious if it’s important to him to communicate something.

(This is maybe not as true as Halthis hopes. Kalorm is getting pretty frustrated with the friction involved in trying to communicate more abstract concepts. He is trying his best to keep a mental list but his working memory is pretty terrible right now and he's leaning a lot on his expectation that he can manage to regenerate the same thoughts again later.) 

He feels much more optimistic about communicating concrete requests! Like right now! Tap suction tubing, point vaguely at his mouth, hand gesture that he intends to mean "turning onto his back", and then attempt to point at the ventilator controls. 

Wow, he has the whole list cued up! Actually pretty impressive! Halthis can't help smiling at him. 

"Just to check I got that right - you're suggesting that you would like suctioning and mouth care, repositioning, and then to try the minimum-settings again?"

She waits for his nod.

"Neat. I'm fully in favor. ...I do want to see if we can get you comfy on your left side, you've spent a lot of time on your back and I'm worried about the pressure on your tailbone, you're not exactly carrying a lot of extra padding. If I'm right that you were wanting to avoid it because your hip is bothering you, I think we can figure out a way to make that work." 

Kalorm can't help rolling his eyes, but - she does have a point, he's also pretty tired of lying flat on his back. And she's been...surprisingly competent at a lot of the little things like that? He still isn't sure how she managed to make "sticking things in his mouth" not very torture. Anyway. Kalorm is not going to go so far as to say he trusts her, but he does - expect her to vaguely know what she's talking about if it's related to whether or not something will be tolerably comfortable? He nods his agreement. 

Halthis pauses with her hand above the console for the IV bolus drugs. "- If you're tolerating it, I want to do a couple of suction passes. I expect your cough reflex will be more effective now, if we're right and getting your magnesium down is helping with general weakness, and I want to set you up as well as possible for the minimum-settings trial, because I have a good feeling about this time. But obviously I won't keep going if you're in distress or - maybe just slap the floor if you need me to stop?" 

Not just because they managed to complete a round of dialysis. She also somehow got him to take, like, more than four hours to actually rest, including some fairly solid sleep. He's on a lower dose of painkillers. And he just seems more there, in some indefinable way. 

There goes literally any chance that Kalorm is going to indicate it to her in any way if he's in horrible pain and would otherwise have wanted her to stop.

It makes sense, though. He, too, would like this time to go better. He's going to try really hard. This one thing is under his control. He may or may not be very very tired after an hour but he is so determined to make it to an hour, one way or another. 

...Halthis is also not sure what that expression means, but it doesn't seem like it's bad. 

Right. Bump O2 on the ventilator up to 100% (because he wanted it in this order and his oxygenation may still be more fragile on his right side), premedication, wait thirty seconds, gentle-but-thorough suction pass - how's he doing - 

It is possible that no one in the entire history of Civilization has applied quite this much sheer concentration and effort to coughing. Kalorm is in fact in quite a lot of pain, but he's also actually quite good at dealing with pain, especially if he has a Goal.

(As usual his lungs have produced a ton of secretions in the last 2 hours, but they're more easily dislodged and the color is now off-white and looks much less like a seriously concerning lung infection.) 

She squeezes his shoulder and says something reassuring, and then has another go. Even more gently, now that his lungs are already going to be a bit irritated. She gets less, this time, and when he sucks in a deep breath afterward and she tunes her earbud to the audio sensors, his lungs sound almost clear. He's flushed and sweaty and his heart rate is way up, but - well, partly thanks to the bonus pre-oxygenation - his O2 sat was rock-steady at 100% the whole time. 

Halthis taps the controls for a dose of beta blockers (and subvocalizes a note to the command center that if they still want to keep his heart rate under 100 they should maybe be considering scheduled doses or even a continuous infusion, she's been pulling that lever kind of a lot) and then dabs tears from his eyes with a tissue. "That was really good. Just rest for a minute." She's going to give him slightly longer to get settled, this time, before risking tickling his gag reflex again. 

Kalorm's chest really hurts right now now! It's okay, though. He's fine. His head doesn't feel at all like it might burst, and he's not even close to involuntarily pointlessly dry-heaving. He's taking very deep breaths just to prove to himself that he can. 

It's pretty impressive! He's moving >1000 ml of air volume per breath and - honestly if he keeps doing that he's going to push his CO2 below the usual parameters, but Halthis will worry about that if and when it happens. 

He looks calmed down. She warns him, and then, again, allows herself exactly sixty seconds for getting his mouth as clean as possible. Now that she's not dealing with an entire previous shift worth of accumulated saliva goo, maybe she can even do a quick pass brushing his teeth... 

They super need it! Merrin basically didn't do it once Kalorm was awake to have objections, and then Kalorm didn't let Tharrim do anything. He allows this, though, partly because it's not actually at any point uncomfortable and partly because he is flooaaaaating and not really sure how to use his body to communicate objections if he had them. Kalorm would maybe be upset about this if it weren't, like, just definitely an improvement over the previous situation. 

He drifts for a few minutes, feeling not very located-in-time, before he can really get his eyes to stay open and manage to gesture, again, that he wants to change position so they can move on to the IMPORTANT things. 

Halthis can't help smiling again. "Okay. I think you're still drugged enough that I'm not going to give you an extra dose for it - just a moment, I'll call in some other people -" 

She previously requested a Stash Of Pillows in a range of shapes and textures - the usual array for patients with Kalorm's approximate body fat composition, customized to his height and particular pain points - which now lives in a cabinet at the far end of the room. She can roll his left hip onto a thin concave soft-foam pillow to distribute the weight, and make sure his right leg is a little bent and well supported on a thicker articulated pillow with a leg-shaped depression down the middle to keep it in place. 

(She gives him some foot and calf stretching while she's at it, since he's previously indicated that he wanted it, and can presumably indicate now if he instead wants Not That.) 

It's good, if not as absolutely incredible as the first time when all of his muscles were apparently desperate for literally any movement. And he does seem to be tolerably comfortable on this side! Probably not indefinitely, but he can actually notice that it feels a little easier to breathe. 

Halthis can notice that too! She's already down to 45% O2 on the ventilator and sort of suspects she could get lower if she does some minor optimization. "Kalorm, one second, I'd like to get a quick ultrasound image of your lungs, and I may want to try some things to improve alveolar tissue recruitment–" she catches herself, that was very medical-jargon, "–sorry, the issue with lying on your right side could be that your lung gets a bit deflated, and we can resolve that faster by pumping up the rate and pressure on the ventilator for a couple of minutes. Okay?" 

Her proposed solutions sounds super uncomfortable but Kalorm is also creeped out about his lung maybe apparently being deflated! Lungs shouldn't do that. He nods. 

...Yep, his right lung is noticeably a bit less well-aerated. 

"All right. This is going to feel pretty weird - slap the floor or something if it's a bad weird - if it's tolerable, just try to relax into it." 

It's a standard lung-recruitment protocol that she can set up in like three keypresses. (After deciding to give him the beta blockers first because people really commonly find it anxiety-inducing.) Two minutes, max-pressure rather than minimum-volume controls, set rate 40 breaths/minute, bump up the continuous post-exhalation pressure to neeaaaarly as high as the inspiratory pressure - wait for Kalorm to breathe out first since it's apparently even more uncomfortable if you don't do that - warn him she's starting and - start. 

This is one of the weirdest experiences of Kalorm's life! It does not feel like the thing he's doing (or rather, that's being done to him) is breathing! Breathing is supposed to involve, like, literally ever breathing out, and this does not really seem allowed right now! 

He closes his eyes and focuses all of his attention on not panicking and staying relaxed and letting the thing-which-is-not-breathing happen to him. Something at least breathing-adjacent must be happening because he doesn't feel like he's suffocating or anything. 

...The two minutes end and the ventilator drops back into normal mode and Kalorm tries to breathe out and immediately starts coughing, because apparently there was SOMEHOW even MORE STUFF in there. The bolus painkillers have mostly worn off and it really hurts, enough that his eyes are watering. 

"Half-dose of the bolus painkiller unless you object," Halthis says, gives him like three seconds to object, and then taps the controls. "Sorry - I think you're just clearing secretions that were way down in your lower airway on the right side - do you need suctioning again–" 

Probably! He's definitely coughing up gunk and there's not really anywhere for it to go otherwise! 

She doesn't actually have to go deep enough to it to noticeably tickle his lungs, he's doing a great job of mostly clearing everything and, yeah, Halthis sort of just has to collect it. She can time it carefully enough that it's not additionally very noticeable to Kalorm on top of the fact that he's already coughing. 

Aaaand ultrasound check...? Wow. 

"That's really good! I expect you'll be able to feel the difference." Also his O2 saturation is still at 100% despite the fact that she didn't up the ventilator O2 concentration when he started coughing, meaning that he almost certainly doesn't need that much. She'll try easing it down to 40% for now.